Provider Demographics
NPI:1003130014
Name:RUBIN, ALEKSANDR (RPH)
Entity Type:Individual
Prefix:
First Name:ALEKSANDR
Middle Name:
Last Name:RUBIN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2113 AVENUE V
Mailing Address - Street 2:STORE#1(PHARMACY)
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-4846
Mailing Address - Country:US
Mailing Address - Phone:718-368-0009
Mailing Address - Fax:718-368-9021
Practice Address - Street 1:2113 AVE V
Practice Address - Street 2:STORE#1
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229
Practice Address - Country:US
Practice Address - Phone:718-368-0009
Practice Address - Fax:718-368-9021
Is Sole Proprietor?:No
Enumeration Date:2010-03-19
Last Update Date:2010-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046443183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist